基质金属蛋白酶9及其基因多态性与冠心病的相关性研究

基质金属蛋白酶（MMPs）是细胞基质降解所必需的锌离子依赖性的内源性蛋白酶家族,是细胞外基质（ECM）的主要生理性调节物质,在基质成分合成和降解的过程中起着重要的作用。对血管系统的基质成分而言,最重要的MMPs是胶原酶和明胶酶。其中明胶酶-B（即MMP-9）在细胞外基质重塑中具有重要作用,在许多病理损伤方面,如冠状动脉粥样硬化斑块不稳定、心室重塑、心力衰竭进展及心血管疾病预后等中亦扮演着重要的角色。     

Risk Factors and Relation Between Clinical,Biochemical Marker and Stenosis Extent of Coronary Artery in Young Adults With Acute Myocardial Infarction

Objectives To analyze risk factors and the relation between clinical, biochemical marker and the stenosis extent of coronary artery in patients below the age of 45 years with acute myocardial infarction （AMI）. Methods A retrospective investigation was performed on 92 patients below the age of 45 with AMI at the First Affiliated Hospital of Medical School of Xi′an Jiaotong University in 2003-2007. The etiology, morbidity, risk factors, clinical features and results of coronary angiography were studied. Various clinical and biochemical markers were assessed to find out what were associated with the stenosis extent of coronary artery. Meanwhile, the differences between one-vessel disease （group A） and two-vessel or multi-vessel disease （group B） patients with AMI were comparatively analyzed. Results Risk factors analysis revealed that a history of cigarette smoking, metabolic disorders and abusive drinking were mainly found in young AMI patients below the age of 45 years, and metabolic disorder mainly consists of decreased high-density lipoprotein cholesterol （HDL-C） and hypertriglyceridemia. AMI in patients below the age of 45 years account for 10.3% of all AMI. Angiographically, the incidence of one-vessel affected was most frequent in the young adults （73.75 %）. The most committed vessel was LAD （80.00 %）. A higher incidence with history of hypertension and diabetes or impaired glucose tolerance was found in group B, but a history of preceding angina 1 month earlier was more frequently found in group A. Improved Genisi scores of coronary angiography was lower in group A than in group B（7.49±3.63 vs 15.08±6.08）. Correlation analysis showed that log（LDL-C/HDL-C）（r= 0.238, P= 0.037）, TC/HDL-C （r= 0.232, P= 0.046） were directly correlated with angiographic scores, and HDL-C（r= -0.202, P= 0.042）was inversely correlated. Multielement gradual linear regression analysis showed log（LDL-C/HDL-C）, TC/HDL-C were associated with the extent of stenosis of coronary artery. Fur     

Clinical Significance of Heart Chronotropic Incompetence in Patients With Coronary Heart Disease

Objectives To investigate the relationship between the chronotropic incompetence and angiographic severity of coronary artery disease, and the clinical value of inappropriate chronotropic responses in exercise. Methods Coronary angiography was performed in 130 patients suspected or diagnosed as coronary heart disease （ CHD）, and angiographic severity of coronary artery disease was quantitated by Duke score and Gensini score. The patients were divided into 4 groups ： non-CHD group （39 cases）, CHD group with only one coronary artery involved （ CHD1, 30 cases）, CHD group with two coronary arteries involved （ CHD2, 31 cases） and CHD group with three coronary arteries involved （CHD3 group, 30 cases ）. A month before coronary angiography, symptom-limited bicycle ergometor exercise had been accomplished, the chronotropic response had been measured and expressed as ratio of heart rate reserve （HRR） and the maximal age-predicted heart rate achieved （rHR）. Results Analysis of variance showed that rHR and HRR were much significantly lower （all P 〈0. 01 ） in CHD2 group （rHR 0. 793 ±0. 078, HRR 0. 626±0. 110） and CHD3 group （ rHR 0. 775 ± 0. 065, HRR 0. 586 ± 0. 125 ） than that in non-CHD group （ rHR 0. 888 ± 0. 062, HRR 0. 798 ±0. 105）and CHD1 group（rHR 0. 857 ±0. 084, HRR 0. 735 ±0. 146）. rHR was similar both between non-CHD group and CHD1 group（ P 〉 0. 05 ） and between CHD2 group and CHD3 group （ P 〉 0. 05 ）. HRR has no difference between CHD2 group and CHD3 group （ P 〉 0. 05 ）, but was significantly different between non-CHD group and CHD1 group （P 〈0. 05 ）. There was a significantly negative correlation between rHR, HRR and Duke score （r = -0. 554, - 0. 578, respectively, all P 〈0. 01 ）, Gensini score （ r = -0. 453, -0. 467 ,respectively, all P 〈0. 01 ）. CHD proportion reached 75% in patients who had positive rHR （ or HRR） and non-ST depression. Diagnostic value [ sensitivity 0. 868 （P 〈0. 01 ）, 0. 846（P 〈0. 01 ?     

Inhibitory Effect of Clopidogrel on Release of Soluble CD40 Ligand by ADP-activated Platelet in Patients With Non-ST-segment-elevation Acute Coronary Syndromes

Objectives To investigate the inhibitory effect of clopidogrel on release of soluble CD40 ligand （sCD40L） by ADP-activated platelet in patients with non-ST-segment elevation acute coronary syndromes（NSTEACS）. Methods Forty-two patients with NSTEACS were treated with clopidogrel for 6 - 8 days. In order to obtain platelet rich plasma （PRP） samples, the venous blood was drawn before and after treatment, respectively. The platelets were activated by adenosine diphosphate （ADP） , thus releasing sCD40L, sCD40L levels were determined by en- zyme-linked immunosorbent assay （ELISA） at different time of the reaction. Results Plasma sCD40L concentration before treatment was （0. 199 ± 0. 155 ） ng/mL, and （0. 190 ± 0. 176） ng/mL after treatment （ P 〉 0.05 ）. Before treatment the PRP sCD40L level at 20-minute of platelet activation was （4.34 ± 2.51 ） ng/mL, and decreased to （2.79 ±1.93 ） ng/mL after treatment （ P 〈 0. 001 ）. The corresponding level at 40 - minute of platelet activation was （5.29 ± 3. 13 ） ng/mL before treatment and （ 2.87 ± 1.59 ） ng/mL after treatment（ P 〈 0. 001 ）. Conclusions Short-term clopidogrel administration might inhibit the release of sCD40L by ADP-activated platelet in patients with NSTEACS, suggesting that, in addition to its antiplatelet potency, clopidogrel may still have an anti-inflammatory effect.     

The Treatment of Ostial Coronary Arteriopathy Secondary to Thoracic Irradiation With Off-pump Coronary Artery Bypass Grafting： A Case Report and Review of Literatures

Objectives We report a case in which a patient who suffered from angina secondary to mediastinal irradiation and have been treated by off-pump coronary artery bypass （OPCAB） in our hospital since 3 years ago. A 34-year-old man presented with angina for 8 years after receiving radiation therapy for Hodgkin＇s lymphoma. We retrospectively reviewed all the cases of OPCAB in our hospital and followed-up data for up to 3 years post-operatively. Mediastinal irradiation is probably the cause of significant ostial stenosis of left main coronary and right coronary artery. OPCAB grafting was performed on this patient 3 years ago. His angina disappeared after operation, and he recovered well during follow-up. Conclusions Patients with malignancies who have received mediastinal irradiation should be carefully followed up and routinely screened for the premature development of coronary artery disease. OPCAB may be an appropriate treatment for coronary artery disease caused by mediastinal irradiation.     

急性冠状动脉综合征抗血小板治疗的新进展

<正>心血管病已经成为中国居民的首要死因。其中,半数为急性冠状动脉综合征(acute coronary syndrome,ACS)所致。现已经阐明,动脉粥样硬化斑块破裂引起血小板激活、黏附和聚集,致使冠状动脉血栓形成,是ACS发病的关键机制。因此,抗血小板是ACS药物治疗的基石。近年来,随着大量临床试验的展开和新型抗血小板药物的临床应用,抗血小板治疗领域取得许多新的突破。1口服抗血小板药物     

Changes of prethrombotic state molecular markers after percutaneous coronary intervention in patients with coronary artery disease with hypertension

Background The changes of pre-thrombotic state molecular markers(PSMMs) were investigated in patients with coronary artery disease(CAD) complicated by hypertension(HBP) after percutaneous coronary in-tervention(PCI), and their significances were evaluated. Methods Totally 70 patients with CAD were divided two groups: group A including 32 patients with CAD, and group B 38 patients with CAD complicated by HBP.All the patients received PCI. The levels of PSMMs were measured before PCI and 20 minutes, 24 hours, and7 days after PCI respectively. The patients were followed up for cardiac events after PCI for 6 months. Results(1) Compared with the data before PCI, the changes in von Willrand Factor(vWF), coagulation fators Ⅷ antigen(Ⅷ:Ag), antithrombin Ⅲ(ATⅢ), granular membrane protein-140( GMP-140), factor Ⅱ activity( F.Ⅱa),fibrinogen(Fbg), plasminogen(Plg), tissue plasminogen activator(t-PA), plasminogenemia activator inhibitor(PAI), and D-dimer were significant at 20 minutes after PCI(P 0.05 or P 0.01), and the changes in vWF,protein C(PC), Fbg, Plg, PAI, D-dimer were significant at 24 hours after PCI in group A(P 0.05 or P 0.01).(2) Compared with the data before PCI, the changes in vWF, Ⅷ:Ag, ATⅢ, GMP1-40, PC, F.Ⅱa, Fbg,PAI, and D-dimer at 20 minutes, 24 hours, and 7 days after PCI were significant in group B(P 0.05 or P 0.01). Conclusions There are significant changes of PSMMs in patients with CAD after PCI, especially in those with CAD complicated by HBP.     

Clinical characteristics of patients readmitted for stroke with double anti-platelet therapy after percutaneous coronary intervention

Background The clinical characteristics of stroke patients treated with double anti-platelet therapy(DAPT) after percutaneous coronary intervention(PCI) is not clear. Methods In total, 2675 patients underwent PCI and DAPT in Guangdong General Hospital, and 68 out of them were hospitalized due to suspected stroke, of whom 23 were diagnosed as having stroke. Data of the 23 stroke patients were collected and traditional risk factors associated with stroke were analyzed retrospectively. Results The mean age of these patients was 75.6 ± 8.7 years, and 20(87.0%) were males. Notably, 19 patients were complicated with hypertension, 7 with diabetes mellitus, 7 with previous history of stroke, none with atrial fibrillation(AF) or patent foramen ovale(PFO). Specifically, 22 patients were diagnosed with ischemic stroke, and 1 patient with hemorrhagic stroke. Conclusion Stroke in patients treated with DAPT after PCI was correlated with advanced age, gender, hypertension, diabetes mellitus, stroke history. Long term electrocardiography(ECG)may be needed for the diagnosis of AF, while trans-esophageal echocardiography(TEE) may be needed for PFO.     

Peroxisome Proliferator-activated Receptor-γ2 Pro12Ala and C-689T Polymorphisms and Haplotypes Affect the Profiles of Coronary Heart Disease in Diabetic Chinese People

Objectives Peroxisome proliferator-activated receptor-γ2（PPARγ2） variant Pro12Ala was demonstrated with risk of coronary heart disease （CHD） and type 2 diabetes mellitus （T2DM）. Another variant C-689T in the promoter was reported with lower receptor activity but lack of reports on association between C-689T and CHD or T2DM. Methods A total of 351 subjects without CHD and T2DM （controls） and 125 patients with CHD and T2DM （cases） were enrolled in our case-control study. Polymerase chain reaction-restricted fragments length polymorphism （PCR-RFLP） was used to detect Pro12Ala and C-689T polymorphisms. And effects on CHD merged with T2DM of the two polymorphisms were analyzed in individual and haplotype analyses. Results In the study, Pro12Pro, Pro12Ala and Ala12Ala genotype frequencies were 92.9%, 6.8% and 0.3% in controls; 92.8%, 7.2% and 0.0% in cases respectively whilst CC, CT and TT genotype frequencies were 93.4%, 6.3% and 0.3% in controls; 92.8%, 7.2% and 0.0% in cases respectively. Pro12Ala and C-689T polymorphisms were in strong linkage disequilibrium （D＇=0.81, P=0.000） and the observed haplotype frequency of Pro-C, Pro-T, Ala-C and Ala-T was 0.957, 0.006, 0.008 and 0.028 respectively. No significant associations were detected between the two polymorphisms and CHD merged with T2DM in either individual or haplotype analyses. In subjects with obesity [body mass index （BMI）≥25 kg/m^2], we found that both Pro12Ala and C-689T polymorphisms were associated with BMI. In haplotype analyses, we found that Pro12Ala and C-689T haplotypes had associations with systolic blood pressure in total population, with BMI, waist circle and total cholesterol（TC） in obesity subgroup and with fasting blood glucose and TC in males. Conclusions PPARγ2 Pro12Ala and C-689T polymorphisms and haplotypes affect the profiles of CHD merged with T2DM in Chinese Han people.     

Association of Atrial Fibrillation and Amino-terminal Pro-brain Natriuretic Peptide Concentrations in Patients After Off- Pump Coronary Artery Bypass Grafting

Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide （NT-proBNP） in the occurrence of atrial fibrillation （AF） after coronary artery bypass grafting （CABG）. Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG. The patients with ejection fraction （EF） less than 0. 30, history of AF, use of class Ⅰ or Ⅲ antiarrhythmic drug, implanted pacemaker, postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded. Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique. Results Postoperative AF occurred in 15 patients （21.4%）; these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation （ P 〈 0. 01 ）. Using multivariate logistic regression analyses, an increase in NT-proBNP level after CABG was found to be independently associated with AF （ OR = 3.78, 95% IC = 1.81 - 4. 89, P 〈 0. 01 ）. Increased age, diabetes mellitus, preoperative use of β-blocker, proximal right coronary artery involvement, and longer operation time were al- so associated with AF. Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG; the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation. The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.     

第37例:临床表现胸痛、反复血便

<正>患者女性,69岁,因"反复活动后胸痛1年"于2012年8月入院。患者自2011年初出现活动时胸前区紧缩感,伴胸闷、大汗,向肩背部放射,持续3⁵ min,休息后可缓解。2012年3月就诊外院心电图示V45 min,休息后可缓解。2012年3月就诊外院心电图示V4^V6导联ST段压低0.1 mV,当时血红蛋白120 g/L,考虑"不稳定型心绞痛",予口服阿司匹林、氯吡格雷、比索洛尔、瑞舒伐他汀治疗,症状有明显缓解。     

先天性冠状动脉瘘5例诊治体会

2007-2013年,我们共收治5例先天性冠状动脉瘘（congenital coronary artery fistula,CAF）患者,现将有关诊治体会情况报道如下.1 病例资料5例患者中男性2例,女性3例,年龄6～67岁.3例有活动后心悸、气短,2例伴心绞痛.查体：心前区可闻及全期连续性杂音,较柔和,Ⅲ级.心电图检查ST段下移2例,心前区导联T波完全倒置1例.2例经心脏超声可见扩张的冠状动脉,确诊后手术.2例经冠状动脉CT确诊,其中1例因合并冠心病又行冠状动脉造影观察冠状动脉走行、狭窄及瘘口部位.1例为二尖瓣狭窄患者,术前未确诊,行二尖瓣置换术,开胸、切开心包后确诊.病例中,右冠动脉-右房瘘1例,右冠动脉-右室瘘1例,左冠动脉-主肺动脉瘘2例,左冠动脉-左室瘘1例.     

Comparison of Ventricular Electrophysiological Effects of Amiodarone in Canine Models With Congestive Heart Failure and Normal Dogs

Objectives This study compared the effects of amiodarone on ventricular electrophysiological properties in normal dogs and CHF dogs. Methods Dogs （n=44） were randomized into four groups： Group 1 （n=10） was the control. Group 2 （n=10） was given amiodarone orally 300 mg·d^-1 for 4 to 5 weeks. Group 3 （n=12） was the congestive heart failure （CHF） models induced by right ventricular rapid pacing （240 pulses·min^-1 for 4 to 5 weeks）. Group 4 （n=12） was the CHF models given amiodarone orally 300 mg·d^-1 for 4 to 5 weeks. The ventricular electrophysiological variables were evaluated by standard electric stimulation and monophasic action potential （MAP） recording. Results Amiodarone prolonged sinus cycle length （SCL）, intra-ventricular conduction time （IVCT）, MAP duration （MAPD90）, ventricular effective period （VERP）, ventricular activation time （VAT） and ventricular recovery time （VRT） without significant effects on the ratio of VERP to MAPD90 （VERP/MAPD90）, ventricular fibrillation threshold （VFT）, the dispersion of VRT （VRT-D）, and ventricular late repolarization duration （VLRD） in normal dogs. However, amiodarone did not further prolong the prolonged SCL, MAPD90, VERP, VAT and VRT, but further prolonged IVCT in CHF dogs. Amiodarone normalized the abnormal ventricular electrophysiological properties in CHF dogs as manifested by increasing the decreased VERP/MAPD90 and VFT, shortening the prolonged VLRD, and decreasing the increased VRT-D. Amiodarone did not worsen the hemodynamic parameters in normal and CHF dogs. Conclusions Amiodarone had different effects on ventricular electrophysiological properties in normal and CHF dogs. The favorable effects of amiodarone in normalizing some abnormal cardiac electrophysiological properties in CHF models may have potential value on the prevention and treatment of ventricular arrhythmias and sudden cardiac death in CHF.     

Changes of Plasma Levels of Brain With Chronic Heart Failure before Natriuretic Peptide in Patients and after Carvedilol Treatment

Objectives To investigate the changes of plasma brain natriuretic peptide （BNP） concentrations in patients with chronic heart failure （CHF） before and after carvedilol treatment. Methods Plasma BNP concentrations of patients with CHF （n = 56） before and after carvedilol treatment and of normal controls （n = 60） were measured with specific radioimmunoassay. Left ventricular ejection fraction of patients with CHF before and after carvedilol was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that plasma BNP concentrations of patients with CHF were significantly higher than that of normal controls [ （222. 65 ± 78.52） ng·L^-1 vs. （38.82 ± 15.31 ） ng·L^-1 , P 〈 0. 01 1. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions （r=-0. 68 ,P 〈 0. 01 ）. After three months treatment of carvedilol, plasma BNP concentrations fell to （79. 65 ±69.52 ）ng·L^-1 （P 〈 0. 01 ）, left ventricular ejection fractions increase from 34. 41% ± 4. 54% to 46. 51% ± 5.38 % （P 〈 0. 01 ）. Conclusions These results indicate that plasma BNP concentrations are increased in patients with CHF, and markedly increased according to the severity of heart failure classified by NYHA classification. Carvedilol can markedly decrease plasma BNP concentrations and improve left ventricular function in patients with CHD.     

Effects of Late Reperfusion on Left Ventricular Function and Its Relationship With Viable Myocardium After Acute Myocardial Infarction in Patients With or Without Diabetes

Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）     

The Utility of B-type Natriuretic Peptide to Predict Prognosis of Acute Myocardial Infarction Patients Complicated With Cardiogenic Shock Treated With Intra-aortic Ballon Counterpulsation

Objectives To assess the prognostic value of B-type natriuretic peptide （BNP） in severe AMI patients treated with intra-aortic ballon counterpulsation（IABP）. Methods A total of 42 AMI patients with cardiogenic shock were retrospectively studied. BNP plasma level was recorded in the 24th hour and 4th day after myocardial infarction. The different mortality were compared among patients with different BNP levels. Results With aggressive treatment, 20 patients survived short term hospitalization. Plasma concentration of BNP in dying patients is much higher than in survivals（1369 ± 353 vs 651 ± 302 pg/ml. P〈 0.01）.Patients with BNP higher than 1474 pg/mL had a mortality of 92.9 %. Conclusions Elevated BNP level in AMI patients with cardiogenic shock treated with IABP is highly associated with poor prognosis.     

Increasing Uric Acid Concentration in Elderly With Ischemic Cardiomyopathy

Objectives Plasma uric acid （UA） concentration was suspected to elevate in elderly with ischemic cardiomyopathy （ICM）. Methods We analyzed the data of 235 elderly aged 60 years and older with coronary heart disease： silent myocardial ischemia or angina pectoris confirmed by angiography. Among these patients, 154 had ICM defined as left ventricular end-diastolic diameter （LVDd） male 〉 55 mm, female 〉 50 mm （mean. 63.51 ± 7.70 mm） measured by echocardiography. Difference in UA was analyzed between patients with and without ICM. Results There was significant increase of UA in ICM compared with non-ICM （432.82 ± 143.05 umol/L vs 361. 06 ± 137.35 umol/L, P 〈 0. 05 ） ; and UA was positively related to LVDd （ r = 0. 25, P 〈 0. 05 ）. Conclusions There was significant increase of UA in elderly with ICM due to longterm silent myocardial ischemia and angina pectoris. Moreover, UA was positively related to LVDd. （ S Chin J Cardiol 2009; 10（4） ： 212 -215）     

国内首例经桡动脉建立轨道的VSD介入封堵术

1 病例资料 患者,女性,36岁,无业。因“心慌、胸闷、气短2年,加重10天”入院。既往体健。查体：胸骨左缘未触及震颤,心界不大,心率68次／min,律齐,A2〈P2,P2亢进,胸骨左缘3-4肋间可闻及3／6级收缩期粗糙杂音,传导广泛;双侧足背动脉搏动正常：生理反射存在,病理反射未引出。     

Changes of Clinical Features of Aortic Dissection Over Ten Years

Objectives To investigate changes of clinical features of aortic dissection （AD） in recent years in Guangzhou. Methods Retrospective analysis of consecutive patients with AD over 10 years in Guangdong Cardiovascular Institute. Demographic features and outcomes in cases presenting with acute dissection were compared between patients admitted in two five-year periods. Results 339 patients with AD were admitted during the recent ten years. Their mean age was 55.7 ± 11.2 years. Male verse female ratio was 4.8. Surgery was performed in 37 % of cases with acute type A and 7 % with acute type B dissection. Apart from a fast increase in number of patients admitted each year, there were no significant changes in demographic characteristics over these ten years. Survival of patients with acute dissection showed a trend of improvement, though it had not been statistically confirmed. Conclusions The number of admitted patients with AD has been fast increasing in Guangzhou. These patients were about ten years younger than previously reported by foreign researchers. Surgery was much less frequently performed than it was in western countries. Survival in acute cases showed a trend of improvement. These data support urgent improvement in prevention and management of aortic dissection.     

两次食管静脉曲张硬化治疗后均发生化脓性胆囊炎1例报告

<正>1病历资料男性,患者,41岁,2007年因乙型肝炎肝硬化、食管胃底静脉曲张破裂出血于外院行内镜下食管静脉曲张硬化治疗术,术后患者出现化脓性胆囊炎,经保守治疗后病情缓解。该患者2013年8月因再次"呕血、黑便1 d"入住威海市立医院,本次住院前曾行B超检查:肝硬化,门静脉高压,脾静脉、肠系膜上静脉、下腔静脉肝后段栓塞,胆囊多发结石,胆囊壁厚。住院后随即行相关化验检查,血常规:白细胞(WBC)4.7×109/L,中性粒